Growing Healthy podcast

Sleep Training 101

We did a segment on a bit more advanced sleep
training issues recently...but we thought we should do one on the
basics....We are going to talk about the core principles of sleep
training for your infant or toddler right after this quick
reminder...

AP: Maria....Sleep...we all need it, it is such an important thing
for our physical and mental health...you know how crabby and
exhausted I am physically and mentally when I don't get
sleep.....

MK: Yup...you are a bit of a crabster and you definetly don't
preform as well at our workouts when you are dragging your butt
after a long call night!!!

AP: That's for sure...and it is the same for our wee ones!!
They need their sleep to be the best kiddos they can be ...and that
is at the core of why we need to help them to learn this skill!

MK: Alicia, that is true. We need to remember that sleep is
a skill that needs to be learnt just like, walking, talking and
having good manners, and it is our responsibility as parents to
help guide our children in learning this important skill. So
much stuff happens when we sleep, we reconcile all we have learnt
that day, we dream, our body heals itself.

AP: Not only that, when our kids sleep, we as parents usually
sleep. One of the major contributors to mental health issues
is lack of sleep, and that is not different in our moms and dads
who are getting sleep deprived in those first months and years
after they have kids. Having an infant that does not sleep,
doubles the risk of depression. And at 6 months of age, 45%
of moms report infant sleep problems....that is almost 1/2 of
moms!!!

MK: Wow....I'm not suprised though...I have a lot of parents who
feel that they are going to cause damage to their kids by "sleep
training" them, or by letting them cry. They feel that their
attachment to their baby will be harmed by these actions. We
have to remember the bigger picture though....we spend so much time
during the day, loving our kids, attending to their needs,
interacting, playing and reading to them that a few minutes of
crying in a 24 hour period will not cause harm. In fact there
are quite a few studies out there comparing children who were sleep
trained vs not and 5 years out there are no differences in the two
groups, at 3 months and 2 years there are...there are benefits to
sleep training in both moms and infants.

AP: It's not easy to hear your baby cry....but putting it in the
context of learning a new skill....it makes it more
understandable....if you child was learning to write, and getting
frustrated about it...you wouldnt just say...well you don't need to
learn to write....would you?

MK: Nope.....so lets get to it!!! We will chat about some
generalities, that are the same regardless of what method you
choose to use to help teach your child to sleep...we will then go
into some of the different ways you can implement them.

AP: What is the most important thing with sleep training? The
same thing with any parenting....Consistency. Kids need
routine, they need to know what to expect. They need to have
boundaries, which they may try to push, but that are
consistent. If they don't have this, they can never learn
what to do.

MK: That's right...so pick a routine and stick to it....Same time
to bed at night, and same time up in the morning, also try to keep
your naptimes around the same time as well. Generally
speaking, around 3 months, you will notice a natural routine that
your child will get into...this is generally a 3 or 4 hour cycle,
of eat, play and sleep. Try to reinforce this.

AP: And then pick a bed time and nap time sleep routine.
Generally the bedtime routine should be about 20-30 min long, and
the nap routine 5-10 min long. As we said kids like routines,
so you need to have something that you can maintain, and that can
be replicated by all those taking care of your wee ones. For
bedtime routines we generally recommend some combination of bath,
book, feed and then put down on their back sleepy but awake.
A cheery good night and out you go. Now some babies fall
asleep while feeding, so if that is the case, you may want to
switch the feed and book/song in the order. For a naptime you
generally want to try to get your child to eat when awakening...so
sleep, eat, play....so your naptime routine might be going into
their room, putting them in their sleep sack etc, reading a quick
book, putting them in their crib, on their back, sleepy but
awake, singing a song and saying a cheerful goodnap.

MK: That is right....but lets remember different aged babies have
different night time requirements....a baby that is 3-4 months of
age still often needs a feed at night, but not more than two.
Most 5-6 month old babies, who have been gaining weight
appropriately, are able to go through the night without a
feed. So, I agree we need to start working on routines, and
allowing the baby to learn how to put themselves to sleep early on,
but we should not be doing formal sleep training, which we are
going to chat about next, until 6-8 months. For those infants
who are older than 6 months and still waking to feed multiple times
at night, you may need to decrease feeds at night prior to doing
full on sleep training. they will naturally start eating more
during the day to make up for it.

AP: exactly...but lets remind everyone...that the longer you wait
to do it, the harder it can be to do!! a 6 month old, usually gets
it within 2-3 nights, where as a 1 year old or 18 month old will
often take closer to a week....Also I think it is important to
remember that all babies and children are different, some are
naturally good sleepers, and other than reinforcing routines, they
don't need much help. Other children need a lot more help to
learn this important skill...so stick to the basics, and it will
work for most infants, but if not...get help....and we've posted a
few books and local resources to contact should you need more
advice. Another thing we need to remember about sleep
training is that this is a team event. So all members of the
household need to be on track with this for it to work....sit down
with your partner, parent or friend, anyone who is willing to help
you out with this and make a plan. because like we said
before children need consistency....so they need to hear a
consistent message between the actions of all
caregivers....othrewise they will get confused. Well
Maria...shall we get down to the nitty gritty of it???

MK: Yup lets do it. We will present you a couple of options,
but you need to find a solution that fits your family, there are
many ways to implement sleep training and not all will work in all
families, so do some research and find a method that your family
can implement together.

AP: We discussed bedtime routine...this needs to be manageable, and
repeatable wherever you are. Kids thrive on consistency and
knowing what to expect, so part of this is bonding with your child
and helping them connect this routine with sleep, so they know that
sleep is the next thing to come. So choose one you can do,
your partner can do or any significant caregiver can do. One
that you can do when you are at home or if you are
travelling. Like we said generally this involves some kind of
feed, book, song and cheery but quiet goodnight.

MK: Bedtime should also be relatively early for most kids in the
infant or toddler stage, say somewhere between 6:30-7:30. If
you wait for your child to show signs of tiredness, or let them get
overtired, it often becomes much harder to get them to sleep.
Some people notice that if their child naps too close to bedtime
they will get harder to put to sleep, others dont notice
this. So if your child is one that a later nap affects their
bedtime significantly, it is probably time to cut out that night if
possible in favour of an early bedtime.

AP: Sleep Environment is very important to baby's sleep. You
want the room temperature to be between 19-21 celsius. If you
need to put extra layers on your child because you cant control the
temperature very effectively, use a sleep sack as they can not be
kicked off. We need to keep loose beddings, pillows etc out
of the baby's bed to make a safe sleep environment.
The room should be dark. This can be challenging to achieve
at some times of years, or during nap times. Invest in a good
pair of black out blinds for these times!.

Background noise can be very helpful for infants and some toddlers,
having a white noise machine (or pink, rain storm etc) as it drowns
out any noise from the outside world but also can remain on all
night (ie not on a timer) , so if the child awakens, it is a
familiar sound that they can then fall back asleep to. The
goal of this is for children to be able to soothe themselves back
to sleep when they wake in the night, which they will, because we
all do....rather than need you to put them back to sleep.

MK: So we have set the stage for good sleep....now how do we
actually make it happen...We have consistent routine, consistent
dark environmnent, good white noise or fan....but a baby that is
awake....

AP: Right...so now you just put the baby down, say a cheery
goodnight and leave....easy as pie!

MK: HAHAHAHAHAHA.....I wish....Well that is the basics of it...but
doesnt work for everyone. Lets start with putting your child
down....Some say put them down drowsy but awake, others say wide
awake....What is the answer? if your child is younger than
3-5 months..they can be drowsy when you put them down, but children
older than that need to be a bit more awake...because those drowsy
ones are have already started to enter that first stage of
sleep....so technically they are not learning how to put themselves
to sleep.

AP: Right...so put them down, awake and wish them a cheery good
night and leave...what about soothers, blankies, stuffies
etc...

MK: Well we want to try to avoid sleep props that they need to put
them selves to sleep with that may not be present when they awake
in the middle of the night...like a soother. If they cant get
it...they will scream for you to come get it for them. So no
soother. A loose blanket and stuffie in the crib is not safe
when your child is young, but may be useful in those toddler years,
but be sure to have a few of the same things in case one gets
lost! and also make sure you rotate them so they all look
worn!

AP: When you say goodnight to your infant, and leave the room, they
may not be happy, and certainly may start crying to get you, their
best friend to come back in and keep them company. They are
smart little people, and of course want to hang out with their best
friends as much as possible, but you have to remember why you are
doing this...to help teach them how to learn the skill of putting
themself to sleep. So the most important part of sleep
training, is having a plan with your partner and sticking to it for
a couple of nights at least. Or resetting your plan together
if you realize your original plan is not working. But the
more you do this, the more confusing it gets to your child, and the
farther away from your goal you are going to get.

MK: Right...so lets talk about a few different ways you can do
this.

Generally speaking, the harder they are on our souls as parents,
the more efficient they are! The easier they are on our
souls, the longer it takes..but that is fine, you need to be
comfortable with whatever way you choose.

1) You can stay in the same room with your child, and shoosh your
child to sleep with out touching them, and then when they are
asleep leave the room, you can expect when your child wakes up in
the middle of the night, they will need you to shoosh them back to
sleep, but over a few nights, you can make the shooshing time
shorter while still remaining in the room until you get to the
point you do not need to shoosh and just be present in the
room. You can then shorten the time you are in the room until
you get to the point that you wish them a cheery goodnight and
leave. I expect this process would take a couple of weeks to
get to the final point.

2) You can say a cheery good night and leave. If your child
starts crying you can then return in, soothe/talk/pat your childs
back to reassure them that you are there and leave again. The
next time you would wait a bit longer before returning. This
will give some children the confidence that you are there if they
need you, but also more quickly teach them the skill to put
themself to sleep. Some babies get more riled up when you go
in, and so this does not work for every family.

3) You can say a cheery good night and leave the room, go sit on
the couch and eat some chocolate...Your child will scream the first
few nights, but probably only for a couple of nights. If you
have en enjoyable bed time routine, and dont get upset about
things, anticipating screaming, they will still enjoy bedtime and
generally will be happy to go to sleep. This method is by far
the hardest on us, but generally the most efficient way. If
after one week, the bedtimes are not getting easier, I would
certainly try another method, as this one may not work for your
child.

AP: okay, so we've talked about how to deal with the first to bed
of the evening, but what about if they awaken during the
night. Well depending on the age, and their need for a feed
overnight you are going to do different things. Some children
between 6-9 months of age still need one feed over night, they will
usually sleep between 6-8 hours and then awaken for a feed then
sleep another 4-6 hours. If your child, over the age of 6
months is awakening more than a couple of times a night, they do
not need to feed. It is very hard, if you are breastfeeding
to not feed a child during then night, they often will not settle
for you if you are the breastfeeding parent, so sending the other
parent in is a good idea, if it is not a feeding time. But
don't run in right away, give your child the opportunity to settle
themself. The older they are the more time you should give
them to settle. Somewhere between 10-20 min from 6 months on.
If they havent' settled you can go in and settle them, ideally
without lifting them up from the crib, and then do the same routine
you chose to do at the beginning of the night. Remember
consistency is key. Children need to know what the rules are
and they need to know what to expect.

MK: The last thing we should chat about is how much sleep infants
and young children need each day. A 3 month old needs about
16-18 hours of sleep, and usually aren't awake for more than 1.5
hours at a time. A 6 month old needs about 14-15 hours and
usually arent awake for more than 2.5 hours at a time. A 9 month
old needs about 14 hours total, and awake time is no more than 3
hours at a time. A one year old needs about about 13.5 hours
total, with awake periods being 3-4 hours at a time. A 18 month old
needs about 13 hours with 1.5-3 hours of napping during the
day. A 2 year old needs about 12 hours a day, with 1-2 being
a nap. Sometimes kids give up naps at this stage and then get
all their napping during the night, some children still continue to
nap, which is fine, as long as they are not pushing back their
bedtimes as a result.